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Spontaneous remission of acute myeloid leukemia
Armin Rashidi1, Stephen I Fisher
1Division of Oncology, Washington University School of Medicine , St. Louis, MO , USA.
Abstract:
Spontaneous remission (SR) of acute myeloid leukemia (AML) is rare. We collected all 46 reported cases of AML with SR. Fever occurred in 91.3% of cases before remission, which was largely due to pneumonia (54.5%) and bacteremia (24.2%). Pneumonia and bacteremia were significantly more common among those who achieved complete remission (CR) compared to those who achieved only a partial remission (p = 0.032). Although 88.6% of remissions were CR, the median duration of remission was only 5 months. Eight cases did not relapse during the follow-up period. The mechanism of SR in AML likely involves the stimulatory effect of systemic febrile infection on the immune system. Immediate treatment of infections and fever may contribute to the rarity of SR in AML. The results of this review improve our understanding of the important role of the immune system in countermanding AML and may provide new ideas for immunotherapy.
Insights
Spontaneous remission of acute myeloid leukemia (AML) is rare, often preceded by infections like pneumonia and bacteremia. Prompt infection treatment might reduce AML spontaneous remission rates, highlighting the immune system's role.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Spontaneous remission (SR) of acute myeloid leukemia (AML) is an exceptionally rare phenomenon.
- Understanding the factors and mechanisms contributing to SR in AML is crucial for advancing leukemia treatment strategies.
Purpose of the Study:
- To review and analyze all reported cases of spontaneous remission in acute myeloid leukemia.
- To investigate the association between infections, particularly febrile illnesses, and the occurrence and depth of AML remission.
Main Methods:
- Systematic literature review of all documented cases of AML with spontaneous remission.
- Analysis of patient data focusing on preceding infections, remission status (complete vs. partial), and relapse patterns.
Main Results:
- A total of 46 cases of AML with SR were identified.
- Fever, predominantly due to pneumonia (54.5%) and bacteremia (24.2%), preceded remission in 91.3% of cases.
- Infections were significantly more frequent in patients achieving complete remission (CR) versus partial remission (p = 0.032).
- While 88.6% achieved CR, the median remission duration was only 5 months, with 8 cases not relapsing.
Conclusions:
- Systemic febrile infections may stimulate the immune system, potentially contributing to spontaneous remission in AML.
- Aggressive treatment of infections and fever might inadvertently reduce the incidence of SR in AML.
- These findings underscore the critical role of the immune system in AML and suggest avenues for novel immunotherapy approaches.
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